Huge Anterior Mediastinal Teratoma Leading to Orthopnea in a Young Patient

The anterior mediastinal cysts and masses (AMCM) can be of varied origin and presentation. Although the space in the mediastinum is limited the cysts and masses can grow to a large size before the presentation. They displace the adjacent structures and then can grow into the pleural cavities thereby acquiring a large size. We share our experience of a case of a huge anterior mediastinal cystic mass in a young female who had a characteristic presentation of sudden onset breathlessness in the supine position and immediate relief in the sitting position. The patient recovered well after surgical treatment.

Clinicopathological spectrum of anterior mediastinal lesions with special reference to the role of cytology in diagnosis: A cross-sectional study

Background: Anterior mediastinal tumors comprise only 3% of all chest tumours. They are often of diagnostic challenge to both clinicians and histopathologists owing to their wide variety of clinical presentations and diversity in histomorphological appearance respectively. Hence, there is a need for elaborated studies to make the pathologists and clinicians aware of their diversity. Aim and Objectives: The present study was aimed to evaluate the diverse spectrum of clinical presentations and histomorphological appearances of anterior mediastinal lesions. In addition, cytological and radiological interpretations were correlated with histological diagnosis to assess their comparative role in diagnosis. Materials and Methods: It was a descriptive observational cross-sectional study. Patients diagnosed with anterior mediastinal mass on chest computed tomography (CT) scan were included in this study. Demographic details including clinical presentations and radiological interpretations were recorded. Patients underwent both CT guided Fine needle aspiration cytology (FNAC) and needle core/excisional biopsy. Histological diagnosis was correlated with radiological and cytological interpretations. Results: Of 659 patients presented with chest tumours, 19 were detected as having anterior mediastinal mass on chest CT scan indicating the prevalence of 2.88%. The most common presenting symptom was respiratory distress (73.68%), followed by chest pain (36.84%), superior vena cava syndrome (26.32%) and Myasthenic features (5.26%). About 50% of malignant tumours occurred at the 2nd decade of life. Thymic epithelial neoplasms comprise the major tumour type in this study (52.63%) followed by germ cell tumors (15.79%) and lymphomas (10.53%). Cytology was found to be more effective compared to radiology in diagnosis. Conclusion: Anterior mediastinal tumors are extremely heterogeneous in clinical presentation and histomorphological appearance. CT-guided FNAC can play an important role in their diagnosis along with radiology and histology.

Quantitative Thoracic Magnetic Resonance Criteria for the Differentiation of Cysts from Solid Masses in the Anterior Mediastinum

OBJECTIVE: To evaluate quantitative magnetic resonance imaging (MRI) parameters for differentiation of cysts from and solid masses in the anterior mediastinum. MATERIALS AND METHODS: The development dataset included 18 patients from two institutions with pathologically-proven cysts (n = 6) and solid masses (n = 12) in the anterior mediastinum. We measured the maximum diameter, normalized T1 and T2 signal intensity (nT1 and nT2), normalized apparent diffusion coefficient (nADC), and relative enhancement ratio (RER) of each lesion. RERs were obtained by non-rigid registration and subtraction of precontrast and postcontrast T1-weighted images. Differentiation criteria between cysts and solid masses were identified based on receiver operating characteristics analysis. For validation, two separate datasets were utilized: 15 patients with 8 cysts and 7 solid masses from another institution (validation dataset 1); and 11 patients with clinically diagnosed cysts stable for more than two years (validation dataset 2). Sensitivity and specificity were calculated from the validation datasets. RESULTS: nT2, nADC, and RER significantly differed between cysts and solid masses (p = 0.032, 0.013, and 0.63; nT2 > 0.39. In validation dataset 1, the sensitivity of the RER, nADC, and nT2 criteria was 87.5%, 100%, and 75.0%, and the specificity was 100%, 40.0%, and 57.4%, respectively. In validation dataset 2, the sensitivity of the RER, nADC, and nT2 criteria was 90.9%, 90.9%, and 72.7%, respectively. CONCLUSION: Quantitative MRI criteria using nT2, nADC, and particularly RER can assist differentiation of cysts from solid masses in the anterior mediastinum.

Radiological interpretation of a small cell neuroendocrine cancer of the lung

Neuroendocrine tumors may develop throughout the human body with the majority being found in the gastrointestinal tract and bronchopulmonary system. Neuroendocrine tumors are classified according to the grade of biological aggressiveness (G1–G3) and the extent of differentiation (welldifferentiated/ poorly-differentiated). The well-differentiated neoplasms comprise typical (G1) and atypical (G2) carcinoids. Large cell neuroendocrine carcinomas, as well as small cell carcinomas (G3), are poorly-differentiated. The identification and differentiation of atypical from typical carcinoids or large cell neuroendocrine carcinomas and small cell carcinomas are essential for treatment options and prognosis. Pulmonary neuroendocrine tumors are characterized according to the proportion of necrosis, the mitotic activity, palisading, rosette-like structure, trabecular pattern, and organoid nesting. These neuroendocrine tumors of the lung arise from Kulchitzky cells of the bronchial mucosa and comprise typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC). Here is a case report of the 75-year-old male patient presented with complaints of a cough and sudden onset of breathlessness and weight. On Computed Tomography (CT) a large heterogeneous lesion noted in the left anterior mediastinum which was subjected to CT guided biopsy. On histopathology and immunohistochemistry, the tumor was confirmed as small cell neuroendocrine tumor.

Clinical value of CEUS guided biopsy in diagnosis of lymphoma in anterior mediastinum / 中国介入影像与治疗学

Objective To explore the clinical value of CEUS guided biopsy of lymphoma in anterior mediastinum.Methods The data of 36 patients with lymphoma of anterior mediastinum underwent biopsy guided by CEUS and 36 patients by conventional ultrasound retrospectively.The successful rate of biopsy and rate of complication occurence were compared between the CEUS group and conventional ultrasound group.Results The successful rate of biopsy in CEUS group was 100％ (36/36),including 26 non-Hodgkin's lymphoma (NHL),10 Hodgkin's lymphoma (HL).The total times of puncture were 60 in 36 patients.The rate of complication occurrence was 11.11 ％ (4/36).The successful rate in conventional ultrasound group was 88.89％ (32/36),including 22 NHL,14 HL.The times of puncture were 91 in 36 patients.The rate of complication occurrence was 41.67％ (15/36).There were significant differences in successful rate and the rate of complication occurrence between two groups (x2 =4.235,8.651,P=0.040,0.003).Conclusion CEUS can reflect the microcirculation of lymphomas in anterior mediastinum,and can guide targeted biopsy.It can improve the successful rate of biopsy and reduce the complications.

Sclerosing liposarcoma of the anterior mediastinum: An unusual case.

Liposarcomas are extremely rare in the mediastinum. Patients usually present late due to the compressive effect of the tumor on the adjacent structures. Severity of the symptoms depend mainly on the size of the tumor and the structure it infiltrates. Well differentiated slow growing liposarcomas are the most common ones in the mediastinum followed by dedifferentiated and poorly differentiated ones. These tumors have bad prognosis because of incomplete surgical excision due to its inaccessible location. Hence these patients should be kept under close follow up because of high recurrent rates. Here we are presenting a rare case of anterior mediastinal sclerosing liposarcoma in a 77 year old male.

Primary Malignant Melanoma of the Mediastinum: Radiologic and Pathologic Correlation in Two Case

Primary malignant melanoma of the anterior mediastinum is extremely rare, accounting for 0.1-0.5% of all primary malignant neoplasms. These tumors may be mistakenly diagnosed as lymphomas, thymic carcinomas and malignant germ-cell tumors of the mediastinum. We describe two cases of primary malignant melanomas of the anterior mediastinum and report their CT and pathology findings.

Imaging Analysis of Lymphoma of Anterior Mediastinum / 实用放射学杂志

Objective To investigate the X-ray and CT features of anterior mediastinal lymphoma.Methods 11 cases with lymphoma of anterior mediastinal confirmed by pathology were collected,the X-ray and CT features were reviewed.Results The tumors in all cases appeared as anterior mediastinal tumor,among them,the tumors in six cases grew at anterior mediastinum bilaterally and in five cases at one-side.There were soft tissue nodi around tumor in eleven cases,superior vena cava were involved in 6,neighborhood blood vessel embed by tumors in 5,pleural effusion could be seen in 3,combined with hydropericardium in one.Conclusion The anterior mediastinal lymphomas have certain imaging characteristics,most of them can be distinguish from other anterior mediastinal malignant tumors if one analysing their imaging features carefuly.